APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION

NAME (LAST, FIRST MIDDLE) / DATE / POSITION APPLYING FOR
PHONE 1 / PHONE 2 / DATE AVAILABLE TO START / PAY DESIRED
ADDRESS / ARE YOU 18 YEARS OR OLDER? / DATE OF BIRTH
CITY, STATE AND ZIP / DO YOU HAVE A VALID DRIVER’S LICENSE? YES or NO
STATE ISSUED BY: NUMBER:
SOCIAL SECURITY NUMBER / ARE YOU ELIGIBLE TO WORK IN THE U.S.? / ARE YOU CURRENTLY EMPLOYED?
*MAY WE INQUIRE THEM?
*NOTE TO APPLICANTS: WE WILL HAVE TO VERIFY AND/OR REQUEST RECORDS AS FEDERAL LAW REQUIRES FOR ANY DOT/FAA DEFINED SAFETY SENSITIVE POSITIONS AND TO SATISFY PRIA (PILOT RECORD IMPROVEMENT ACT) REQUIREMENTS.
PLEASE LIST YOUR HIGHEST LEVEL OF EDUCATION.
DID YOU GRADUATE? IF SO, WHEN?
NAME OF SCHOOL, INSTITUTE, COLLEGE, UNIVERSITY, ETC. PHONE NUMBER

LICENSES AND CERTIFICATES

LIST BELOW. THOSE ISSUED BY THE FAA MAY BE COPIED & VERIFIED. PILOTS INCLUDE MEDICAL (WITH CLASS) HERE AS WELL.

TYPE / NUMBER / DATE ISSUED / DATE EXPIRES

OTHER INFORMATION ABOUT YOU

HAVE YOU EVER BEEN CONVICTED OF A FELONY? YES or NO / ANSWERING YES WILL NOT NECESSARILY EXCLUDE YOU FROM CONSIDERATION.
IF YES, PLEASE EXPLAIN.
DO YOU HAVE ANY SPECIAL NEEDS, CONDITIONS OR CIRCUMSTANCES WE MAY NEED TO ACCOMMODATE? YES or NO / ANSWERING YES WILL NOT EXCLUDE YOU FROM CONSIDERATION.
IF YES, PLEASE EXPLAIN.
ALL PILOT, MECHANIC AND TECHNICIAN, FLIGHT OPERATIONS, AND NON-ADMINISTRATIVE APPLICANTS:
ARE YOU IN OVERALL GOOD PHYSICAL HEALTH AND ABLE TO LIFT AND MANUEVER HEAVY ITEMS IN, OUT AND AROUND AIRCRAFT, VEHICLES, OR EQUIPMENT?
YES or NO

GTA Air, Inc. is an equal opportunity employer.

BACKGROUND INFORMATION

PLEASE PROVIDE INFORMATION FOR 5 YEARS PRECEEDING THE DATE OF THIS APPLICATION. LIST THE DATES OF YOUR SCHOOLING OR EDUCATION, EMPLOYMENT, OR PERIOD(S) OF UNEMPLOYMENT. EXPLAIN ALL PERIODS OF TIME WHEN UNEMPLOYED OR OUT OF SCHOOL. DATES MAY BE LISTED IN MONTH AND YEAR FORMAT (i.e., 12/1996). FAILURE TO PROVIDE INFORMATION WILL RESULT IN THE APPLICATION BEING REJECTED OR RETURNED. USE EXTRA SHEETS IF NECESSARY.

LEAVE ALL SHADED AREAS BLANK. THESE AREAS ARE FOR OFFICE USE ONLY.

BACKGROUND 01

START DATE: / END DATE: / CIRCLE ONE: EMPLOYER SCHOOL UNEMPLOYED
NAME OF COMPANY OR SCHOOL / POSITION OR TITLE / NAME OF SUPERVISOR
STREET ADDRESS / DESCRIPTION OF WORK: / REASON FOR LEAVING:
CITY, STATE ZIP
PHONE NO. / FAX NO. / VERIFIED BY: DATE: EL – IN4RH
NAME OF PERSON CONTACTED:

BACKGROUND 02

START DATE: / END DATE: / CIRCLE ONE: EMPLOYER SCHOOL UNEMPLOYED
NAME OF COMPANY OR SCHOOL / POSITION OR TITLE / NAME OF SUPERVISOR
STREET ADDRESS / DESCRIPTION OF WORK: / REASON FOR LEAVING:
CITY, STATE ZIP
PHONE NO. / FAX NO. / VERIFIED BY: DATE: EL – IN4RH
NAME OF PERSON CONTACTED:

BACKGROUND 03

START DATE: / END DATE: / CIRCLE ONE: EMPLOYER SCHOOL UNEMPLOYED
NAME OF COMPANY OR SCHOOL / POSITION OR TITLE / NAME OF SUPERVISOR
STREET ADDRESS / DESCRIPTION OF WORK: / REASON FOR LEAVING:
CITY, STATE ZIP
PHONE NO. / FAX NO. / VERIFIED BY: DATE: EL – IN4RH
NAME OF PERSON CONTACTED:

BACKGROUND 04

START DATE: / END DATE: / CIRCLE ONE: EMPLOYER SCHOOL UNEMPLOYED
NAME OF COMPANY OR SCHOOL / POSITION OR TITLE / NAME OF SUPERVISOR
STREET ADDRESS / DESCRIPTION OF WORK: / REASON FOR LEAVING:
CITY, STATE ZIP
PHONE NO. / FAX NO. / VERIFIED BY: DATE: EL – IN4RH
NAME OF PERSON CONTACTED:

BACKGROUND 05

START DATE: / END DATE: / CIRCLE ONE: EMPLOYER SCHOOL UNEMPLOYED
NAME OF COMPANY OR SCHOOL / POSITION OR TITLE / NAME OF SUPERVISOR
STREET ADDRESS / DESCRIPTION OF WORK: / REASON FOR LEAVING:
CITY, STATE ZIP
PHONE NO. / FAX NO. / VERIFIED BY: DATE: EL – IN4RH
NAME OF PERSON CONTACTED:

BACKGROUND 06

START DATE: / END DATE: / CIRCLE ONE: EMPLOYER SCHOOL UNEMPLOYED
NAME OF COMPANY OR SCHOOL / POSITION OR TITLE / NAME OF SUPERVISOR
STREET ADDRESS / DESCRIPTION OF WORK: / REASON FOR LEAVING:
CITY, STATE ZIP
PHONE NO. / FAX NO. / VERIFIED BY: DATE: EL – IN4RH
NAME OF PERSON CONTACTED:

BACKGROUND 07

START DATE: / END DATE: / CIRCLE ONE: EMPLOYER SCHOOL UNEMPLOYED
NAME OF COMPANY OR SCHOOL / POSITION OR TITLE / NAME OF SUPERVISOR
STREET ADDRESS / DESCRIPTION OF WORK: / REASON FOR LEAVING:
CITY, STATE ZIP
PHONE NO. / FAX NO. / VERIFIED BY: DATE: EL – IN4RH
NAME OF PERSON CONTACTED:

AUTHORIZATION FOR RELEASE OF INFORMATION

I understand that the information that I report on the employment application (including any supplements) will be subject to verification by background investigation. F.A.R. Regulation #107 requires that such a background check be conducted. I agree to allow and cooperate with the investigation of my background. I also agree not to hold GTA Air, Inc., its employees or contractors liable in connection with the inquiries. I understand and agree that credit information, criminal history, worker’s compensation, driving record, and other information may be obtained concerning me.

For the purpose of the background investigation required by 49 U.S.C. 44936 (f)(1)(B), I hereby authorize the release of any and all information about me from previous employers, any government subdivision, holders of public records, law enforcement agencies, credit reporting entities and agencies, any public or private person who might have material information about me, and the companies, schools and persons’ names in the GTA Air, Inc. Application for Employment (including any supplements). I further agree to release any such entity or individual from any and all liabilities and damages in releasing such information.

In the event that the investigation reveals any undisclosed additional information, I then agree that such issues may be fully examined and shall be encompassed in the release listed above in such inquiries.

I certify that all information and facts contained herein are true and complete to the best of my knowledge. I fully understand that should I become employed by GTA Air, Inc., falsified statements on this application and its supplements shall be grounds for termination without recourse.

I authorize investigation of all statements and facts contained herein pertaining to the references, schools and employers listed herein to disclose to GTA Air, Inc. and its authorized representatives any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release said company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of GTA Air, Inc. has any authority to enter into any agreement for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This Application for Employment does not constitute an offer of employment nor create a contract for employment of any form.

I have read and understand this authorization. Further more, I agree to said authorization in its entirety.

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PRINT NAME HERE (FIRST MI LAST) SOCIAL SECURITY NO.

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SIGNATURE DATE

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